| Part Ⅰ The value of CEUS and elastography in the diagnosis of localty advanced breast cancerObjectiveTo study the characteristics of conventional ultrasound,CEUS and elastography of bcal advanced breast cancer,and to provide help for the imaging diagnosis of local advanced breast cancer.Masterials and methodsFrom May 2018 to April 2019,36 patients(40 lesions)with bcally advanced breast cancer were diagnosed by clinkal evaluation and puncture biopsy in the outpatient or inpatient clinic of the Cancer Hospital and Institute,Peking Union Medical College and Chinese Academy of Medical Science.From the clinical evaluation,these patients were recommended to undergo pre-operative neoadjuvant chemotherapy followed by surgery.All patients underwent conventional ultrasound,CEUS and elastography before puncture.Summarize and analyze ths characteristics of conventional ultrasound,CEUS and elastograpty of breast cancer with the purpose of further clarifying the value of CEUS and elastography in the diagnosis of breast cancer.Results1.Features of conventional ultrasound:in this study,the most type of local advanced breast cancer was tumor type(80.0%,32/40),and all lesions were characterized as irregular form.Most lesions showed unclear boundaries(39/40,97.5%),uneven echoes(38/40,95.0%),and internal calcificatbns(24/40,60.0%),which included 20 cases of microcalcifications(50.0%)and 4 cases of both micro-and-macro calcifications(10.0%).Most lesions had hyperechoic halos(31/40,77.5%),aspect ratio less than or equal to 1(34/40,85.0%),and bbod flow grading was Ⅲ(36/40,90.0%).The mean maximum transverse diameter of the tumor was 3.86±1.79cm,the mean maximum anteroposterior diameter was 2.27±0.86cm and the mean maximum upper and lower diameter was 3.26±1.49cm.2.Features of CEUS:compared with the surrounding normal tissues,all the lesions showed high enhancement(40/40,100.0%)and uneven enhancement(35/40,87.5%).Some lesions showed low,equal or no enhancement(11/40,27.5%).The enhancement mode was mainly fast in and slow out(39/40,97.5%),and there was "solar sign" in 25 lesions(25/40,62.5%).The average arrival time was 9.46±4.40s,the average peak arrival time was 18.40±5.09s,the average peak strength was 23.35±4.02 dB,and the area under the average curve was 2048.00±457.00.3.Characteristics of elastography:the average visual elastography score of the lesions was 4.28±0.67,the maximum strain rate(E1)of the lesions averaged 4.88 ± 0.54,the strain rate of normal tissue(E2)in the same level averaged 0.96±0.15,the E1/E2 averaged 5.23 ± 1.05,and the overall strain rate of the lesion averaged 4.14±0.72.ConclusionsIn locally advanced breast cancer,the main conventional ultrasonography usually shows irregular shape and unclear boundaries.Miciocalc ification is common,and the aspect ratio is less than or equal to 1.CEUS showed uneven enhancement of "fast in and slow out",and "solar sign" was often seen.Elastography showed that the texture of the lesion was significantly stififer than the sinrounding normal tissue,and the hardness distribution inside the lesion was uneven Conventional ukrasoimd combined with CEUS and elastography can provide help for die diagnosis of breast cancer,especially the diagnosis of locally advanced breast cancer.Part Ⅱ The value of CEUS and elastography in the evaluation of neoadjuvant chemotherapy for breast cancerObjectiveTo explore the value of conventional ultrasound,CEUS and elastography in the evaluation of NAC in breast cancer.Masterials and methodsFrom May 2018 to April 2019,patients to be treated for NAC breast cancer were included at the Cancer Hospital and Institute,Peking Union Medical College and Chinese Academy of Medical Science.The enrolled patients were examined by conventional ultrasound,CEUS and elastography before the beginning of chemotherapy,after the first cycle of chemotherapy,after the second cycle of chemotherapy,and after the treatment.They were also examined by MRI before chemotherapy,after the second cycle of chemotherapy,and after the treatment.The size changes of conventional ultrasound,CEUS and MRI were recorded,and the relevant parameters were obtained through quantitative analysis of CEUS and elastography.Finally,the postoperative pathological results and clinical outcomes of the disease were compared and analyzed.The study aimed to explore the value of conventional ultrasound,CEUS and elastography in the efficacy evaluation of breast cancer NAC.Results1.This study included 28 patients with breast cancer after NAC treatment(28 lesions).There were 26 cases(26 lesions)of invasive ductal carcinoma,including 1 case with high-grade ductal carcinoma in situ.Invasive micropapillary carcinoma of breast was found in 2 cases(2 lesions).Among the patients,24 cases(24 lesions)were treated with surgery,and 4 cases(4 lesions)were treated with distant metastasis during chemotherapy.2.Among breast cancer patients,NAC treatment was effective in 7 cases and ineffective in 21 cases.The age of the ineffective group was higher than that of the effective group(p<0.05).3.After NAC treatment,the APD values measured by conventional ultrasound were all lower than those measured by CEUS,MRI and postoperative pathotogy(p<0.05).However,there was no significant difference between CEUS,MRI and pathological size in APD measurement(p<0.05).There were no statistically significant differences in the TD values of conventional ultrasound,CEUS,MRI and postoperative pathology(p>0.05).4.After NAC treatment,the differences were significant(p<0.05)between the effective group and the ineffective groop in the ultrasound(APD values,APD rate of change and area rate of change),CEUS(APD values,area rate of change,perimeter rate of change and PI value)as well as the elastography(E1,E1 rate of change and E1/E2 value).5.For the corrprehensive evaluation of curative effect by conventional ultrasound,the sensitivity,specificity and accuracy after one cycle were 100%,57.1%and 89.3%,respectively.After two cycles,the sensitivity,specificity and accuracy of conventional ultrasound evaluation were 100%,71.4%and 78.6%,respectively.The sensitivity,specificity and accuracy of evaluation after treatment were 71.4%,95.2%and 82.1%,respectively.The sensitivity,specificity and accuracy of CEUS were 60.9%,100%and 71.4%,respectively.After two cycles,the sensitivity,specificity and accuracy were 100%,76.2%and 75.0%,respectively.The sensitivity,specificity and accuracy after treatment were 100%,61.9%and 71.4%,respectively.For the comprehensive evaluation of efficacy by ekstograpty,elastography only had the evaluation efficacy after treatment,and the sensitivity,specificity and accuracy were 85.7%,85.7%and 85.7%,respectively.Conclusions1.For the NAC size assessment of breast cancer,CEUS is superior to conventional ultrasound and has a high degree of consistency with MRI and pathology.2.The indicators of conventional ultrasound include:APD,APD rate of change,and area rate of change.CEUS indexes included:APD,PI,rate of change in circumference,and rate of change in area.Some indexes of elastography include E1,the rate of E1 change,and E1/E2.All have statistical significance in evaluating the efficacy of NAC for breast cancer.3.In the early evaluation of NAC treatoent for breast cancer(one cycle),the evaluation methods have not shown good diagnostic efficacy;CEUS was siperior to conventional ultrasound after two cycles.Elastography can only evaluate after treatment,and the efficacy of the three is similar after NAC treatment. |
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